Since the beginnings of the crack epidemic, the drug has been viewed as a sexual stimulant and enhancer, as well as the cause of excessive sexual behavior in many users. Reports from the field and in the media have indicated that crack is the "ultimate turn-on"; that crack users readily engage in a variety of sexual activities, at any time and under any circumstances, and with an abundance of partners; that crack use has initiated a "new prostitution" and the crack house has become the "new brothel"; and that the numerous rates of sex-for-crack exchanges in some locales are increasing the spread of HIV infection (Chiasson et al., 1991; Fullilove and Fullilove, 1989; Grant, 1988; Greve, 1989; Inciardi, 1989). The association between crack use and apparent excessive sexual behavior has been evident in numerous ethnographic analyses of the crack scene (Ratner, 1993). Indeed, the tendency of crack users to engage in high-frequency sex with numerous, anonymous partners is a feature of crack dependence and crack house life in many locales (Bourgois, 1989; Hamid, 1990; Inciardi, 1992, 1993; Treaster, 1991; Williams, 1992). Much of the sexual activity associated with crack houses occurs in a separate bedroom specifically provided for sexual activities. However, sex acts also occur in the more public smoking rooms as well. Although many street prostitutes who barter sex for money to purchase drugs often insist that their customers use condoms, this is not usually the case with crack house sex. In fact, condoms are rarely seen in crack houses. Given the health status of crack users (including a high likelihood of compromised immune systems), the incidence of STDs (many of which go untreated), and general lack of condom use, many of the conditions that have contributed to the heterosexual transmission of HIV in Africa exist in crack houses in Miami, New York, Philadelphia, and other urban areas across the United States. In addition, given the frequency of sex and the large number of partners associated with crack house sex, the potential for coming into contact with HIV through heterosexual sex is even greater.
To understand this situation, one must consider a few things about cocaine and crack. First, cocaine's (and hence crack's) potent psychic dependence has been well documented (Washton and Gold, 1987). Compulsive users seek the extreme mood elevation, elation, and grandiose feelings of heightened mental and physical prowess induced by the drug. When these sensations begin to wane, a corresponding deep depression is felt, which strongly motivates users to repeat the dose and restore their euphoria. Thus, when chronic users try to stop using crack, they often are plunged